Baber, Usman; Spirito, Alessandro; Sartori, Samantha; Angiolillo, Dominick J; Briguori, Carlo; Cohen, David J; Collier, Timothy; Dangas, George; Dudek, Dariusz; Escaned, Javier; +17 more... Gibson, C Michael; Han, Ya-Ling; Huber, Kurt; Kastrati, Adnan; Kaul, Upendra; Kornowski, Ran; Krucoff, Mitchell; Kunadian, Vijay; Vogel, Birgit; Mehta, Shamir R; Moliterno, David; Sardella, Gennaro; Shlofmitz, Richard A; Sharma, Samin; Steg, Philippe Gabriel; Pocock, Stuart; Mehran, Roxana; (2023) Clinically Driven Revascularization in High-Risk Patients Treated With Ticagrelor Monotherapy After PCI: Insights from the Randomized TWILIGHT Trial. The American journal of cardiology, 208. pp. 16-24. ISSN 0002-9149 DOI: https://doi.org/10.1016/j.amjcard.2023.09.008
Permanent Identifier
Use this Digital Object Identifier when citing or linking to this resource.
Abstract
Repeat coronary revascularization is a common adverse event after successful percutaneous coronary intervention. This analysis aimed to assess the effects of ticagrelor monotherapy on repeat clinically driven revascularization (CDR). In the TWILIGHT (Ticagrelor With Aspirin or Alone in High-Risk Patients after Coronary Intervention) trial, after 3 months of ticagrelor plus aspirin, high-risk patients were maintained on ticagrelor and randomly allocated to aspirin or placebo for 1 year. The primary end point of this analysis was CDR within 12 months after randomization. The key secondary end points were major adverse cardiovascular and cerebrovascular events (MACCEs), a composite of all-cause death, myocardial infarction, stroke, or CDR, and net adverse clinical events (NACEs), including the individual components of MACCEs and clinically relevant bleeding. The analysis was performed in the per-protocol population. CDR occurred in 473 of 7,039 patients and was associated with a significantly higher risk of subsequent all-cause death, myocardial infarction, or stroke (adjusted hazard ratios [HRs] 2.92, 95% confidence interval [CI] 1.82 to 4.67). Ticagrelor monotherapy was associated with a similar 12-month risk of CDR (7.1% vs 6.6%; HR 1.09, 95% CI 0.90 to 1.30, p = 0.363) and MACCEs (8.9% vs 8.6%; HR 1.04, 95% CI 0.89 to 1.22, p = 0.619), and a lower risk of NACEs (12.2% vs 14.6%; HR 0.83 95% CI 0.73 to 0.94, p = 0.004) than ticagrelor plus aspirin. In conclusion, among high-risk patients who underwent percutaneous coronary intervention, ticagrelor monotherapy after 3 months of ticagrelor-based dual antiplatelet therapy was associated with a similar risk of CDR and MACCEs and a decrease of NACEs (TWILIGHT: NCT02270242).
Item Type | Article |
---|---|
Faculty and Department | Faculty of Epidemiology and Population Health > Dept of Medical Statistics |
PubMed ID | 37806185 |
Elements ID | 210191 |
Official URL | http://dx.doi.org/10.1016/j.amjcard.2023.09.008 |
Download
Filename: Baber-etal-2023-Clinically-Driven-Revascularization-in-High-Risk-Patients.pdf
Description: This is an author accepted manuscript version of an article accepted for publication, and following peer review. Please be aware that minor differences may exist between this version and the final version if you wish to cite from it.
Licence: Creative Commons: Attribution-Noncommercial-No Derivative Works 4.0
Download